Healthcare Provider Details

I. General information

NPI: 1003751371
Provider Name (Legal Business Name): KATHRYN VINCENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 LINDEN AVE
DAYTON OH
45432-3043
US

IV. Provider business mailing address

1628 E DOROTHY LN
DAYTON OH
45429-3810
US

V. Phone/Fax

Practice location:
  • Phone: 937-365-7455
  • Fax: 937-600-6071
Mailing address:
  • Phone: 937-365-7455
  • Fax: 937-600-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: